Sunday, August 11, 2013


    Many of us know that when we breath the Helium , our voice changes . We have tried this when we were kids , and it was funny to talk in a different voice , may like a duck . The reason is that the helium is less dense than the room air . This has been made use of in treating asthma . When we breath the 'lighter'  gas , then the resistance to the air flow is reduced . In case of asthmatic attack , the bronchial tubes are in spasm . So the  person who is in attack , has shortness of the breath . This feels like breathing through a straw . So when the patient is given the lighter gas , like Helium , the resistance to air flow ( or the gas flow ) is reduced and the shortness of breath is improved . This is a short term solution . As the treatment improves the narrowed airway, then helium is discontinued .But today the story that I am going to tell is very different .
     I had known this patient , we will call him John . He was diagnosed to have advanced COPD . This was due to his  smoking in the past . He was on oxygen all the time . He was diagnosed to have got a lung cancer about 3 years and since he was not a surgical candidate , to re sect the tumor , he got radiation treatment and that seems to have 'cured ' him . Recently he was having some more trouble . He had a respiratory infection , and he continued to feel poorly and more short of breath . We gave him an antibiotic and a another , added several courses of steroid and he was still not his 'usual' . I continued him on the steroid for long time and gave an appointment in 6 weeks or so . So when I saw him in office in less than 2 weeks , I was surprised . I asked him as to why he came so soon . His wife started telling me the reason . But she did not have to describe his problem , as when he started talking , I knew why he was in my office soon . His voice had changed . Now many a timed when patients have a lung cancer and the voice changes , we suspect an involvement of the nerve going to the vocal cord . The nerve that goes to the left vocal cord has a long route , It goes down in the chest , then winds around the left main bronchus and then goes back to the neck and goes to the vocal cord . So during the long course of the nerve , especially in the chest, it can get caught in the cancer process -spread and then the voice changes . But his voice change was not like that , but was more like the one that we have with the helium inhalation . They both had noticed it and so though he was not more short of breath , he decided to come to office . I listened to his lungs and they were clear and there was good air movement.  His oxygen level was OK too . But when I felt in the neck , I could feel the air in the soft tissues of the neck .
     THIS WAS THE CAUSE OF HIS CHANGE OF VOICE . He had ruptured  one of  the air sacks and the air had leaked  in to the neck . Some how it was causing the voice change . I am not sure how the voice change ocures, but I have seen it . So I decided to get him in the hospital . for the observation . Fortunately his lung had not collapsed , and he did not need much intervention. We did the CT scan of the chest and the CT scan of the neck , and it confirmed the diagnosis . He was released in 2 days , and is doing fine .The cancer that he had , had nothing to do with his voice change (thank God ).

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